title: Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart.
abstract: BACKGROUND
  Primary airway adenoid cystic carcinomas (ACCs) are rare neoplasms and challenging to resect completely. The objective of the current study was to evaluate clinical and pathologic features and indicate prognostic factors based on different tumor locations in the airway.
  
  
  METHODS
  From March 2001 to April 2012, 82 consecutively operated patients were enrolled in this study with pathologically confirmed airway adenoid cystic carcinomas in the Shanghai Chest Hospital. Clinical and pathologic data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier and log-rank tests. Multivariate analysis was performed using the Cox regression model.
  
  
  RESULTS
  The ACCs originating from the bronchus were associated with older age (p = 0.021), had fewer positive margins (44.8% vs 84.9%, p < 0.001), and more involved lymph nodes (55.2% vs 14.3%, p = 0.002) than their tracheal counterparts. The overall survival after resection of all ACCs was 90.6% at 5 years and 56.4% at 10 years. Five and 10-year disease-free survival was 66.9% and 11.2%, respectively. Multivariate analysis indentified only dyspnea as a presenting symptom to predict tracheal disease-free survival (hazard ratio = 0.062, 95% confidence interval = 0.005 to 0.785, p = 0.032). Bronchial ACCs had worse disease-free survival than tumors of tracheal origin (p = 0.001).
  
  
  CONCLUSIONS
  Adenoid cystic carcinoma in the bronchus behaves more aggressively than its tracheal counterpart. Only dyspnea as a presenting symptom predicts better disease-free survival after resection of tracheal ACCs.
authors.affiliation: Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, People's Republic of China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhao
authors.forename: Heng
authors.initials: H
authors.lastname: Zhao
authors.forename: Limin
authors.initials: L
authors.lastname: Fan
authors.forename: Jianxin
authors.initials: J
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D003528:Carcinoma, Adenoid Cystic / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014134:Tracheal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery
keywords: 15